The study evaluated the relationship between 28-day mortality and a procalcitonin
decrease of more than 80% between baseline and hospital day 4 in ICU patients with
severe sepsis or septic shock.

Change in procalcitonin levels can predict mortality among patients with severe sepsis
or septic shock, according to a recent study.

The prospective observational study included consecutive patients with severe sepsis
or septic shock admitted to the ICU at 13 U.S. hospitals. Of 858 enrolled patients,
646 were alive and in the hospital on day 4. Their procalcitonin levels were measured
daily over the first five days of hospitalization. The primary outcome of the study
was 28-day mortality, and researchers looked for a relationship between this outcome
and a procalcitonin decrease of more than 80% between baseline and hospital day 4.

Patients who did not experience such a decrease had double the risk of death at 28
days (20% vs. 10%; P=0.001), the study found. The inability to decrease procalcitonin by more than 80%
was confirmed as an independent predictor of mortality in a Cox regression analysis,
which adjusted for demographics, Acute Physiology and Chronic Health Evaluation II
score, ICU residence on day 4, sepsis syndrome severity, antibiotic administration
time, and other confounders (hazard ratio, 1.97; 95% CI, 1.18 to 3.30; P<0.009).

The findings are in line with other research finding prognostic utility to serial
procalcitonin measurement, the study authors said. They noted that determining sepsis
prognosis is difficult with currently available tools, and biomarkers have been seen
as a promising solution. This study supports the approach of monitoring procalcitonin
levels over time, the authors said, noting that their secondary analysis showed that
a procalcitonin increase even from baseline to day 1 could predict mortality, as patients
with an increase had a threefold higher risk. “This simple finding could prove
particularly useful during early critical care management,” they wrote.

The authors cautioned that procalcitonin change is not such a precise measurement
that it should be used in decisions to withdraw care from patients unlikely to survive.
They called for an interventional study to determine whether serial monitoring of
procalcitonin can improve clinical decisions and outcomes for sepsis patients. The study was published online by Critical Care Medicine on March 2.

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